POS0063 PROGRESSIVE INTERSTITIAL LUNG DISEASE IS FREQUENT ALSO IN LATE DISEASE STAGES IN SYSTEMIC SCLEROSIS PATIENTS FROM EUSTAR
Authors: A. M. Hoffmann-Vold, C. Brunborg, P. Airò, L. P. Ananyeva, L. Czirják, S. Guiducci, E. Hachulla, M. Li, C. Mihai, G. Riemekasten, P. Sfikakis, G. Valentini, O. Kowal-Bielecka, Y. Allanore, O. Distler
Journal: Annals of the Rheumatic Diseases (2022)

Background Short disease duration is a predictor for progressive systemic sclerosis-associated interstitial lung disease (SSc-ILD), but studies assessing ILD progression in later disease stages are lacking. To individually tailor management of ILD in SSc patients in clinical practice it is, however, of high importance to understand disease behaviour also in patients with late disease. Objectives Analyse ILD progression in SSc-ILD patients from the EUSTAR cohort segregated by subgroups of disease duration. Methods We segregated SSc-ILD patients into four categories of disease duration (≤3 years, &gt;3- ≤7 years, &gt;7- ≤15 years and &gt;15 years after onset of Raynaud’s phenomenon). We assessed progressive ILD, defined as forced vital capacity (FVC) decline &gt;10% or FVC decline ≥10% and FVC decline 5–10% and diffusing capacity of the lungs for carbon monoxide (DLCO) decline ≥15% (composite decline) over the first and second 12+/-3 months period after first registration (baseline) into EUSTAR. Clinical characteristics, pulmonary involvement, treatment at first registration and ILD progression were evaluated by descriptive statistics. Results In total, 2258 SSc-ILD patients were included, with 469 (20.8%) having a disease duration ≤3 years, 550 (24.4%) between &gt;3- ≤7 years, 752 (33.3%) between &gt;7- ≤15 years and 488 (21.6%) of &gt;15 years (Table 1). Baseline characteristics and treatment patterns differed between the four subgroups, with more younger male patients with diffuse cutaneous SSc, anti-topoisomerase I antibody and higher Rodnan skin score having ≤3 years disease duration. Lung function with FVC and DLCO were similar between the four groups (Table 1). Notably, in the first and second 12+/-3 months periods after first registration in the EUSTAR database, there were no significant difference in FVC decline &gt;10% or composite FVC and DLCO decline within the four subgroups. For example, patients with disease duration &gt;7- ≤15 years and &gt;15 years frequently showed disease progression of FVC &gt;10%: 41/347 (11.8%) and 32/228 (14%) compared to 38/244 (15.6%) and 33/273 (15.6%) for disease duration ≤3 years and &gt;3- ≤7 years (P=0.529), respectively (Figure 1). Table 1. Demographics and baseline clinical characteristics of EUSTAR patients Disease duration ≤ years(n=460) &gt;3- ≤7 years(n=550) &gt;7- ≤15 years(n=752) &gt;15 years(n=488) p-value Age, years (SD) 55 (13.5) 55 (14.1) 57 (13.1) 61 (11.5) &lt;0.001 Male, n (%) 123 (26.2) 115 (20.9) 112 (14.9) 38 (7.8) &lt;0.001 DcSSc, n (%) 228 (56.4) 262 (45.8) 311 (45.4) 163 (31.2) &lt;0.001 ATA, n (%) 236 (53.4) 293 (55.9) 374 (52.8) 218 (48.0) 0.099 mRSS, mean (SD) 12.3(10.1) 10.4 (8.3) 9.4 (8.1) 8.7 (7.7) &lt;0.001 GERD, n/N (%) 273 (58.7) 353 (64.4) 482 (64.4) 344 (71.2) 0.001 ESR, mean (SD) 26.9(21.7) 24.2 (19.5) 26.2 (19.9) 28.3 (21.2) 0.022 MMF, n/N (%) 33 (16.6) 43 (25.2) 37 (20.4) 14 (9.3) 0.002 MTX, n/N (%) 19 (10) 17 (10.1) 19 (10.6) 8 (5.2) 0.296 Any IS, n/N (%) 81 (38.6) 89 (47.1) 82 (40.8) 46 (28.7) 0.006 FVC % pred, mean (SD) 86 (20.9) 87 (21.6) 86 (21.4) 87 (22.8) 0.770 DL CO % pred, mean (SD) 58 (19.3) 59 (19.3) 59 (19.9) 58 (19.7) 0.405 NYHA class 3&amp;4, n (%) 84 (18.6) 78 (14.6) 125 (17.5) 22.6 (7.0) 0.090 Figure 1. FVC decline &gt;10% and composite FVC and DLCO decline in the first and second 12+/-3 months within the four subgroups segregated by disease duration Conclusion It was long believed that ILD burned out in late disease stages. In our analysis of ILD progression by four disease duration categories, we showed that ILD frequently progressed also in late disease stages. This has important implications for clinical practise, as SSc patients need to be regularly monitored for ILD progression independent of disease duration. Disclosure of Interests Anna-Maria Hoffmann-Vold Speakers bureau: Actelion, Boehringer Ingelheim, Jansen, Lilly, Medscape, Merck Sharp &amp; Dohme, Roche, Consultant of: Actelion, ARXX, Bayer, Boehringer Ingelheim, Jansen, Lilly, Medscape, Merck Sharp &amp; Dohme, Roche, Grant/research support from: Boehringer Ingelheim, Cathrine Brunborg: None declared, Paolo Airò Speakers bureau: Bristol-Myers-Squibb, Boehringer Ingelheim, Consultant of: Bristol-Myers-Squibb, Grant/research support from: Bristol-Myers-Squibb, Roche, Jannsen, CSL Behring, Lidia P. Ananyeva Speakers bureau: Boehringer Ingelheim, Grant/research support from: Boehringer Ingelheim, László Czirják Speakers bureau: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Actelion (now GSK), MSD, Novartis, Pfizer, Roche, Lilly, Grant/research support from: Boehringer Ingelheim, Actelion (now GSK), MSD, Novartis, Pfizer, Serena Guiducci: None declared, Eric Hachulla Speakers bureau: GSK, Roche-Chugai, Johnson &amp; Johnson, Boehringer Ingelheim, Consultant of: CSL Behring, GSK, Roche-Chugai, Johnson &amp; Johnson, Boehringer Ingelheim, Grant/research support from: CSL Behring, Boehringer Ingelheim, GSK, Roche-Chugai, Sanofi Genzyme, Mengtao Li: None declared, Carina Mihai Speakers bureau: MEDtalks Switzerland, Mepha, Grant/research support from: Roche, Boehringer Ingelheim, Janssen, Gabriela Riemekasten Speakers bureau: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Petros Sfikakis Consultant of: Boehringer Ingelheim, Gabriele Valentini Consultant of: Boehringer Ingelheim, Grant/research support from: Sanofi/BMS, Otylia Kowal-Bielecka Speakers bureau: Boehringer Ingelheim, Novartis, Pfizer, Gilead Sciences, Janssen-Cilag, MEDAC, MSD, Abbvie, Sandoz, Consultant of: Boehringer Ingelheim, Health Care system Navigator, CSL Behring, MSD, Novartis, Grant/research support from: CSL Behring, Boehringer Ingelheim, Abbvie, Roche, MEDAC, Yannick Allanore Speakers bureau: Boehringer, Abbvie, Consultant of: Boehringer, Bayer, Astra-Zeneca, Prometheus, Sanofi, Genentech/Roche, Boehringer, Grant/research support from: Alpine Immunosciences, OSE Immunotherapeutics, Medsenic, Oliver Distler Speakers bureau: Bayer, Boehringer Ingelheim, Janssen, Medscape, Consultant of: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, 4P Science, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur, Grant/research support from: Kymera, Mitsubishi Tanabe, Boehringer Ingelheim